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General NPI Number Information
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NPI Number | 1154873685
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Entity Type | Individual
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Provider Name | MARLON JOHNSON LPC, LICDC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 1744 PAYNE AVE
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City | CLEVELAND
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State | OH
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Zip | 44114-2910
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Country | US
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Telephone | 216-623-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 4314 S PARKSIDE DR
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City | BROOKLYN
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State | OH
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Zip | 44144-2724
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Country | US
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Telephone | 216-970-8307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162004
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2202779
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License Number State | OH
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